Definition
1. Dislocation at MCP, most often involving thumb
Types of Metacarpal-phalangeal (MCP) Dislocation
1. Simple Dislocation
  1. Dislocation without interposed soft tissue
2. Complex Dislocation
  1. Soft tissue interposed in the joint
  2. Requires surgical reduction
Management: Simple Dislocation
1. Reduction (dorsal dislocation)
  1. Flex wrist
  2. Hyperextend dislocated joint as far as possible
  3. Push base of proximal phalanx distally
  4. Bring joint back into flexion while pushing base
  5. Avoid simple traction (risk of complex dislocation)
2. Post-reduction joint assessment
  1. Assess joint range of motion
  2. Assess collateral ligaments with MCP flexed
3. Immobilization for 3 weeks
  1. Direction of dislocation
    1. Dorsal dislocation: Splint 20-30 degrees of flexion
    2. Volar dislocation: Splint to maintain extension
      1. Discuss with local orthopedic consultants
  2. Finger involved
    1. Thumb MCP dislocation: Cast thumb for 3 weeks
    2. Finger MCP dislocation: Buddy tape for 3 weeks
Management: Complex Dislocation
1. Reduction usually impossible by closed method
  1. Joint does not snap back into place
  2. Joint does not feel reduced
  3. Reduction prevented by soft tissue in joint
2. Surgery usually needed
  1. Open reduction and internal fixation (ORIF)

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.